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系統識別號 U0026-1908201517552100
論文名稱(中文) 台灣老年人中醫醫療利用行為之初探
論文名稱(英文) Health Care Utilization of Chinese Medicine among Elderly People in Taiwan
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 103
學期 2
出版年 104
研究生(中文) 魏廉鴻
研究生(英文) Lien-Hung Wey
學號 TC6021057
學位類別 碩士
語文別 中文
論文頁數 107頁
口試委員 指導教授-劉立凡
召集委員-洪裕強
口試委員-古鯉榕
中文關鍵字 中醫門診  老年人  負二項回歸  頻次分析  醫療行為 
英文關鍵字 Chinese medicine  Elderly  Health care utilization  Negative binomial regression 
學科別分類
中文摘要 目的:探討台灣65歲以上老年人中醫門診利用行為及因素,了解一年內有醫療需求曾使用中醫老年人之族群特性,分析影響其使用頻次的相關因素,並探討不同年度台灣老年人中醫使用者的特性是否有所不同。
方法:以國民健康訪問調查資料(NHIS)之65歲以上樣本為研究對象。分析的樣本中,26.04 % 及 26.75 %分別於2005年與2009年使用中醫,串聯全民健康保險就醫紀錄分析相關因素與中醫門診使用的關係,經排除與插補後分析有效樣本1620與2449人。依據醫療服務利用行為模型(behavioral model of health services utilization)歸納樣本特性,分別使用雙變量分析、羅吉斯回歸、零膨脹負二項回歸分析門診使用和頻次與使用者特性,排除未使用者並考慮中醫使用型態後,使用負二項回歸分析門診頻次與使用者的關係,最後使用合併年度樣本納入年度變項分析2005年與2009年中醫使用是否有所差異。
結果:2005年26.04%樣本與2009年26.75%樣本曾使用中醫,兩年度因「肌肉骨骼系統及結締組織疾病」與「癥候、徵候及不明情況」就診之人次最多,與中醫門診就診相關的因素包含年齡、性別、教育程度、中風病史、高血壓病史、疼痛程度、投保身分、抽菸習慣、運動習慣。與中醫使用頻次相關的因素包含經濟狀態與糖尿病病史,進一步排除未使用者後,經濟狀態、高血壓病史、糖尿病病史、中醫使用型態與中醫使用頻次相關;合併年度模型中,時間因素與中醫使用和頻次皆不具統計學相關。
討論與結論:使用與未使用、低頻次與高頻次使用中醫的老年人具有不同的特性,不同年度其特性略有不同。本研究發現影響選擇使用中醫與使用頻次的因素可能不相同,另外相較於西醫,中醫對台灣老年人為較具斟酌性之醫療形式。模型的差異上,就診相關分析中零膨脹負二項回歸模型較羅吉斯回歸分析嚴謹,頻次分析控制就醫型態後負二項回歸模型有較好的控制。
英文摘要 The aim of this study is to investigate the utilization of traditional Chinese medicine (TCM) clinics among elderly people in Taiwan. Elderly people aged 65 years and over were analyzed by using data from the National Health Interview Survey (NHIS) and National Health Insurance Research database (NHIRD) in Taiwan. Valid samples were 1620 and 2449 for year 2005 and 2009. We analyzed users’ characteristics which may influence their outpatient clinics utilizations and frequencies by bivariate analysis, logistic regression, zero-inflated negative binomial regression and negative binomial regression according to the data attritions. Demographic information of TCM users included age, gender, education level, insurance status, smoking habits, exercise habits and physical conditions such as history of stroke, history of hypertension, pain condition were significantly associated with TCM usage. Before excluding the non-users, economic status and history of diabetes were significantly associated with high frequency use of TCM. However, after the exclusion, economic status, history of hypertension, history of diabetes, and medical type of traditional Chinese medicine were shown to be related to high frequency utilizations of TCM. There was no significant association between the time variable and TCM usage or high frequency utilizations of TCM in the consolidated sample. Our study indicated that elderly people exhibited different characteristics, in terms of TCM utilizations and frequencies. It is concluded that TCM is a more discretionary medical care for elderly people in Taiwan compared to Western medicine.
論文目次 考試合格證明 I
中文摘要 II
Abstract III
謝誌 V
目錄 VI
圖目錄 VIII
表目錄 IX

一、 緒論 1
1. 研究背景及動機 1
2. 研究目的 3
二、 文獻分析 4
1. 替代醫療與中醫 4
2. 醫療利用行為之相關理論 6
3. 老年人醫療利用行為 11
4. 影響替代醫療利用的因素 13
5. 台灣中醫政策的演變與現況 18
三、 研究方法 20
1. 研究架構及研究假說 20
2. 資料來源與研究對象 21
3. 研究變項定義與測量 22
4. 統計方法 26
5.資料處理 27
四、 研究結果 30
1. 基本資料描述 30
2. 中醫使用概況 32
3. 中醫使用與其相關因子雙變量分析 33
4. 中醫使用有無與其相關因子多變量分析 35
5. 中醫使用頻率與其相關因子多變量分析 38
五、 研究討論 41
1.研究目的與研究發現 41
2.中醫使用概況探討 42
3.中醫使用有無之因素探討 43
4.中醫使用頻次之因素探討 46
5. 中醫使用時間之因素探討 47
6. 醫療服務利用模型與中醫使用47
六、 研究結論 49
1. 研究結論 49
2. 研究限制 49
3. 研究貢獻 50
七、 研究圖表 52
八、 參考文獻 102
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